025 Benefit of Drug Eluting Stents over Bare Metal Stents after Rotational Atherectomy. A propensity score adjusted comparison in revascularization, mortality and MACE

RationaleRotational atherectomy makes possible to attempt small and calcified arteries while Drug Eluting Stents (DES) properties may reduce the restenosis process, rendering this combination attractive in selected cases. We compared 1year clinical outcome after rotational atherectomy following by either DES or Bare Metal Stents (BMS) implantation.MethodsSingle centre registry including all consecutive cases of rotational atherectomy use. Clinical follow-up was obtained in all patients. Propensity score for being treated with a DES was calculated using 18 clinical, angiographic and procedural variables. Comparison was adjusted on 4 strata of the propensity score.ResultsBetween 2002 and 2008, 223 patients were treated: 114 with BMS and 110 with DES. Most of the patients with BMS between 2002 and 2004 and later with DES. No significant difference was observed in clinical characteristics between groups: age 70 years, reference diameter 2.40±0.60mm, lesion length 10±9mm. Two cases of coronary perforation occurred, 7 lesion failure, and 12 transcient no-reflow. The use of GP2b3a inhibitors was similar in both groups, but, compared with BMS, patients in the DES group had longer duration of combination of aspirin and Clopidogrel. At one year, significantly lower rates of vessel revascularisation (2% vs 12%, p=0.005), of all cause mortality (5% vs 14%, p=0.05) and of MACE (10% vs 22%, p=0.02) were observed in the DES than in the BMS group. Adjustment on the strata of the propensity score did not change significantly these results (figure).ConclusionsDespite propensity score adjusted, this comparison has limitations. After rotational atherectomy we observed clear benefit for DES implantation over BMS on vessel revascularisation, mortality and MACE rates

Energy and decay width of the pi-K atom

The energy and decay width of the pi-K atom are evaluated in the framework of the quasipotential-constraint theory approach. The main electromagnetic and isospin symmetry breaking corrections to the lowest-order formulas for the energy shift from the Coulomb binding energy and for the decay width are calculated. They are estimated to be of the order of a few per cent. We display formulas to extract the strong interaction S-wave pi-K scattering lengths from future experimental data concerning the pi-K atom.Comment: 37 pages, 5 figures, uses Axodra

Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis

BACKGROUND: Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. METHODS AND RESULTS: Outcomes of 361 consecutive patients (mean age, 59.1\ub115.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. CONCLUSIONS: A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE

Efficacité et sécurité d'emploi de l'enoxaparine comme traitement adjuvant à la thrombolyse dans l'embolie pulmonaire massive et sub-massive

BESANCON-BU Médecine pharmacie (250562102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Etude de radioprotection en salle d'hémodynamique lors des procédures de valvuloplasties aortiques percutanées

BESANCON-BU Médecine pharmacie (250562102) / SudocSudocFranceF

015 Impact of discharge heart rate on 30 day mortality in patients with acute myocardial infarction

BackgroundIn patients with acute myocardial infarction (MI), beta-blockers are recommended and contribute to control the heart rate (HR). The factors associated with HR and outcome of patients discharged with HR>70 beats per minute (bpm) is poorly documented.MethodsProspective registry including patients with acute MI. Recorded variables corresponded to the CARDS dataset. The proportion of patients discharged with HR>70bpm was assessed. Multivariate regression was used to determine factors associated with HR at discharge and logistic regression was used to determine the prognostic value of high HR at discharge on 30 day mortality.ResultsAmong the 837 patients, 592 survived and were discharged with a beta blocker. Discharge HR was ≤70bpm in 61% when a betablocker was given and in 31% without beta blocker (p<0.001). Discharge HR was associated with older age, admission HR, admission systolic blood pressure, BNP level, diabetes, use of beta blockers and ACEI. Patients discharged with HR>70bpm (n=227, 39%) had a threefold higher mortality as compared with those with HR ≤70 (figure). Multivariate analysis showed that a HR ≥70 at discharge was an independent predictor of 30 day mortality on top of the GRACE risk score and use of beta blockers.ConclusionsAmong patients discharged after acute MI, those with HR>70 have higher 30 day mortality, independently of the GRACE risk score and use of beta blockers.Mortality by discharge heart rat